MEDICARE: MR. GARRY LEE ZEMBOWER JR. LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	27040913A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27040913A	OTHER	IN	PRACTICAL NURSING LICENSE

General Provider Information

NPI Number	:	1689877466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARRY LEE ZEMBOWER JR. LPN

Provider Business Mailing Address
First Line	:	6508 W SWEET CREEK DR
Second Line	:
City	:	NEW PALESTINE
State	:	IN
Zip	:	46163-9567
Country	:	US
Telephone Number	:	317-529-8310
Fax Number	:

Provider Business Practice Location Address
First Line	:	6508 W SWEET CREEK DR
Second Line	:
City	:	NEW PALESTINE
State	:	IN
Zip	:	46163-9567
Country	:	US
Telephone Number	:	317-529-8310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	07/08/2007

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